Eligibility Provisions

This is a mandatory form that dictates how Hometown Health enrolls, modifies, and terms your employees and their spouse/dependents.

• Please review your group’s Eligibility Provisions annually to ensure you follow the correct timelines for enrollment and terminations. The best time to review the Eligibility Provisions is during open enrollment. If you do not have a copy, please let your team know and we will provide that for you.

• Members can be added during Open Enrollment, Qualifying Life Events or New Hire initial enrollment period.

• Coverage Options:

  • Commencement of Coverage: Date of Hire or Bona Fide employer-based waiting period.

  • Waiting Period: First of the month on or following __ days of eligible employment (Not to exceed 60 days).

  • Termination of Coverage:

    • Small Group will always be end of month which employee ceases to be eligible.

    • Large Group can be end of month which employee ceases to be eligible or midnight date of termination. If the group is first of the month, they will be end of the month for terms. If the group is date of hire, they have the option to be end of month OR date of term.

  • Eligibility Provisions will be consistent with your Employee Handbook.

  • Note – waiting period is based on calendar days. Please count days (not months).

  • Changes to provisions only allowed during Open Enrollment.